MAR-OMA-65

Code
MAR-OMA-65
Mercy ID
V-03339-01
Encounter Date
06/04/2010
Last
Marulanda
First
Omaira
DOB
01/22/1965
County
Walton
Street
2407 Meretith Dr.
City
Loganville
State
GA
Zip
30052-
Cell
(678) 925-5878
Family Status
Two parent family w/children
COB
Colombia
Gender
Female
Housing
Single Family
Education Level
College Degree

Spouse Information

Last
Bryalt
First
Robert
DOB
12/02/1964
Address
N/A
Telephone
N/A
COB
USA
Home Owner
No
Driver
No
Home Owner
YES
SOLO
No
Court Mandated
No
Program Completed
No
DFCS Mandated
No
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
No
Consentimiento De Participar
No

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
No
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Keiri Gonzalez 02/13/2001 Mother w/Stepfather GA/USA
Marcela Bejarano 09/02/1993 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Gonzalez
First
Leonardo
DOB
10/10/1957
Telephone
N/A
COB
Puerto Rico
Home Owner
YES
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Juana